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Neurology > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

What are the three kinds of spontaneous intracranial haemorrhage?

A

SAH- subarachnoid haemorrhage ICH- intracranial haemorrhage IVH- intra-ventricular haemorrhage

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2
Q

How does SAH present?

A
  • Sudden onset severe headache
  • Collapse
  • Vomiting
  • Neck pain
  • Photophobia
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3
Q

What is the DDx of sudden onset headache?

A
  • SAH
  • Migraine
  • Benign coital cephalgia
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4
Q

What are the clinical signs of SAH?

A
  • neck stiffness
  • photophobia
  • decreased conscious level
  • focal neurological deficit (dysphasia, hemiparesis, IIIrd nerve palsy)
  • Fundoscopy- retinal or vitreous haemorrhage
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5
Q

CT brain may be negative if >_ days post SAH

It is negative in __% of patients who have bled

A

CT brain may be negative if >3 days post SAH

It is negative in 15% of patients who have bled

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6
Q

When is lumbar puncture safe?

A

In alert patient with no focal neurological deficit, no papilloedema, or after normal CT scan

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7
Q

What would be seen in LP post SAH?

A

Bloodstained or xanthochromic CSF tap (6-48hr)

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8
Q

How is cerebral angiography used in SAH?

A

Gold standard but may occasionally miss aneurysm fue to vasospasm

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9
Q

Describe CA in SAH

A

Seldinger technique via femoral artery. 4 vessel angiography with multiple views

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10
Q

What are the complications of SAH?

A
  • re-bleeding
  • delayed ischaemic deficit
  • hydrocephalus
  • hyponatraemia
  • seizures
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11
Q

Rebleeding after SAH is often _____.

20% risk in first __ days

50% risk in first _ months

A

Rebleeding after SAH is often fatal.

20% risk in first 14 days

50% risk in first 6 months

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12
Q

What is the managment for rebleeding?

A

Endovascular techniques

Surgical clipping

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13
Q

What is DIND? When does it occur?

A

Delayed ischaemic neurological deficit

Occurs days 3-12 after stroke

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14
Q

How does DIND present?

A

Altered conscious level or focal deficit

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15
Q

What causes DIND?

A

Vasospasm

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16
Q

What is the management of DIND?

A

Nimodipine

High fluid intake ‘triple H therapy’

17
Q

How does hydrocephalus present?

A

Increasing headache or altered conscious level

18
Q

What is the treatment for hydrocephalus?

A

CSF drainage, LP, EVD, shunt

19
Q

Describe hyponatraemia post SAH?

A

SIADH or cerebral salt wasting

Often transient

20
Q

How is cerebral salt wasting managed?

A

DO NOT fluid restrict

Supplement sodium intake

Fludrocortisone

21
Q

Post SAH the risk of seizures is _% acute and __% 5 year risk

A

Post SAH the risk of seizures is 3% acute and 10% 5 year risk

22
Q

Intracerebral haemorrhage is bleeding into the _____ ______. __% are secondary to hypertension, 30% are due to ______ or _______ _______.

A

Intracerebral haemorrhage is bleeding into the brain parenchyma. 50% are secondary to hypertension, 30% are due to aneurysm or arteriovenous malformation.

23
Q

What are the two causes of hypertensive intracerebral haemorrhage?

A

Basal ganglia haematoma

Charcot-bouchard microaneurysms

24
Q

Where do Charcot-bouchard microaneurysms arise?

A

Small perforating arteries

25
Q

What is the presentation of ICH?

A

Headache

Focal neurological deficit

Decreased conscious level

26
Q

What is the treatment of ICH?

A

Surgical evacuation of haematoma +/- treatment of underlying abnormality

Non-surgical management

27
Q

What is the prognosis of ICH?

A

Good- if small superficial clot and good neurological status

Poor- if large basal ganglia or thalamic clot with major focal deficit or deep coma

28
Q

When does intraventricular haemorrhage occur?

A

With rupture of a subarachnoid or intracerebral bleed into a ventricle

29
Q

What are AVMs?

A

Arteriovenous malformations

30
Q

What usually happens in an AVM? Where are they usually located and what causes them?

A

Shunting of blood: arterio->venous

Usually intraparenchymal

Congenital

31
Q

What can AVMs cause?

A

Seizures

Haemorrhage- intracerebral, subarachnoid, subdural

Headache

Steal syndrome

32
Q

What is the treatment for AVMs?

A

Surgery

Endovascular embolisation

Stereotactic radiotherapy

Conservative

Weigh risks against benefits

Neurology (41 decks)

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